Abstract
Background. Posttransplant lymphoproliferative disorders (PTLDs) occur after solid organ transplantation. Treatment guidelines include reduction in immunosuppression (RIS), radiation, rituximab, chemotherapy, and immunological agents. We present a rare case of recurrent diffuse large B-cell lymphoma presenting as a PTLD in a heart transplant patient treated with autologous blood stem cell transplant (ASCT) after failure of conventional therapy. Case Presentation. A 66-year-old male presented with a neck mass. He has a history of Hodgkin's disease status after staging laparotomy with splenectomy and heart transplantation due to dilated nonischemic cardiomyopathy 8 years prior to the development of PTLD. His examination was remarkable for right submandibular swelling. An excisional biopsy confirmed the diagnosis of diffuse large B-cell NHL. Patient received RIS, rituximab, chemotherapy, and radiation therapy with a complete remission. His lymphoma relapsed and he subsequently was treated with RICE salvage chemotherapy and consolidative high-dose chemotherapy with BEAC regimen followed by ASCT resulting in a complete remission. Conclusion. Patients with PTLD present a difficult therapeutic challenge. In this case, the patient's prior history of Hodgkin's disease, splenectomy, and a heart transplant appear to be unique features, the significance of which is unclear. ASCT might be a promising therapy for patients with relapsed or refractory PTLD.
Highlights
Posttransplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of benign and malignant entities that occur in the setting of solid organ or allogeneic hematopoietic cell transplantation in the setting of immunosuppression [1]
We present an unusual case of diffuse large B-cell type Non-Hodgkin’s Lymphoma (NHL) presenting as a PTLD in an adult with a history of Hodgkin’s disease, splenectomy, and heart transplant treated with autologous blood stem cell transplant (ASCT) after failure of conventional therapy
PTLD may develop at any time following organ transplantation; its risk is highest during the first year [1]
Summary
Posttransplant lymphoproliferative disorders (PTLDs) occur after solid organ transplantation. A 66-year-old male presented with a neck mass He has a history of Hodgkin’s disease status after staging laparotomy with splenectomy and heart transplantation due to dilated nonischemic cardiomyopathy 8 years prior to the development of PTLD. His examination was remarkable for right submandibular swelling. Patient received RIS, rituximab, chemotherapy, and radiation therapy with a complete remission His lymphoma relapsed and he subsequently was treated with RICE salvage chemotherapy and consolidative high-dose chemotherapy with BEAC regimen followed by ASCT resulting in a complete remission. Patients with PTLD present a difficult therapeutic challenge In this case, the patient’s prior history of Hodgkin’s disease, splenectomy, and a heart transplant appear to be unique features, the significance of which is unclear. ASCT might be a promising therapy for patients with relapsed or refractory PTLD
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